We conducted a retrospective study from 2013 to 2018 which included 99 patients with clinically relevant benign thyroid nodules who met the eligibility criteria and provided written informed consent.
None of our patients were treated with RFA because of difficult management of post-surgical hypothyroidism.
Thyroid nodules were clinically assessed with a symptomatic score using a 10-cm visual analog scale (0-10) and a cosmetic grading score (1,
no palpable mass; 2,
no cosmetic problem but a palpable mass; 3,
a cosmetic problem on swallowing only; and 4,
an easily detected cosmetic problem).
We performed indirect laryngoscopy for evaluanting cord funcionality and laboratory tests for evaluating thyroid hormones and antibodies and coagulation status.
All nodules proved to be benign in two separate fine needle aspiration biopsy (FNAB).
Characteristics of the nodules were evaluated before treatment: size,
margins,
and proportion of the solid and cystic portions,
echogenicity,
vascularity and presence of calcifications.
Contrast enhanced ultrasonography (CEUS) was also performed immediately before and after the RFA.
RFA was suggested as the first-line treatment for solid nodules (solids >80%),
a combination of EA and RFA for mixed nodules (solid between 20-80%) and EA alone for cystic nodules (solid <20%).
RFA was performed using a cool-tip RF system with a straight-type internally cooled electrode with a 1-cm active-tip and a RF generator (Starmed®).
1-2% mepivacaine was used for anesthesia along the trajectory described by the needle.
Clinical and imaging follow-up was performed at 1,
3,
6 and 12 months after treatment.
Therapeutic success was defined as a > 50% volume reduction 6 months from treatment.
Statistical evaluation was performed using the Kruskal-Wallis test or Fisher's exact test for continuous quantitative and qualitative variables.
Multiple linear regression analysis was calculated to identify factors that were independently predictive of efficacy.
SPSS software version 21 (SPSS,
Inc.,
Chicago,
IL) was used.
A two-tailed p-value <0.05 was considered statistically significant.